Sugar Wars

Sugar Wars

In a new Nourishment Network feature, two sides of a hot nutrition debate go toe to toe. This month, to round off Carbs and Sugar Month, we are looking at the ever controversial subject of sugar.

In the red corner, Simon Langley-Evans, Professor of Human Nutrition at the University of Nottingham on the dangers and futility of demonizing a single ingredient.

And in the blue corner, Jenny Rosborough, Registered Nutritionist and Campaign Manager for Action on Sugar, on why some focus is important in the battle for the nation’s health.

Let’s get ready to rumble……

The Demonization of Sugar

Simon Langley-Evans – Head of School of Biosciences & Professor of Human Nutrition, University of Nottingham

Action on Sugar is a highly effective and well-organised pressure group which is working towards an improvement in the health of the nation, by combating obesity. They aim to educate the public and work with the food industry to reduce the sugar content of processed foods and to improve labelling. In many respects I share their aims as the need for a strategy to prevent obesity, particularly in children, is inarguable.

However, the campaign of AOS focuses wholly on a single component of the diet. Obesity is a disease with multifactorial origins. This makes the problem much more difficult to solve than salt and hypertension, which was the focus of the predecessor of AOS- Action on Salt. Humans gain weight because of their genetic predispositions (at least a third of risk), their level of physical activity and the energy content of their whole diet in relation to the energy they expend. Focusing on just sugar as a means of addressing the nation’s weight problem is like applying a sticking plaster to a gushing arterial wound. Although AOS may deny that they are doing so, they contribute to a clear demonization of sugar (the white death). This approach is a waste of financial resources, time and effort. Obesity will continue to increase unabated regardless of the widely-celebrated sugar levy and the regular shock-horror revelations that particular foods have a high content of added sugar. The failure will arise firstly because the majority of consumers will not be moved by a small increase in price and do not understand or wish to engage with public health messages. We know this because other public health nutrition initiatives fail with the majority of consumers. Most people are aware of the 5-a-day message, but very few manage to accommodate it within their diets. Furthermore, targeting sugar alone will fail because energy from all sources (sugar, fat, alcohol, starch, protein) in excess of requirement will drive weight gain.

In trying to implement a one-ingredient approach to changing the nation’s diet, AOS is doing nutrition professionals a huge disservice. In 5-10 years time, when the total failure of this approach becomes clear, the public will, yet again, perceive that nutritionists were wrong, have given the wrong advice and let everyone down. The inappropriate focus on sugar as the chief driver of obesity and the totally unachievable goal of reducing intakes of added sugar to less than 5% of dietary energy, comes at a time when the nutrition profession is already vulnerable. We are drowned out by the quacks and snake-oil salesmen on social media and by the voices of celebrities and medically trained, but non-nutrition specialists. AOS associates with some of these people and very successfully uses their bandwagons to market the AOS aims. This does the rest of us a disservice and will be damaging.

Addressing the obesity issue will depend on the creation of environments where physical activity and healthy eating are normalised and made easy. Sugar is just one element of a broader approach to lifestyle modification.

Response: The Demonization of Action on Sugar

There are many approaches to improving population nutrition. Campaigning for nutrition policies is fundamentally different to educating on healthy eating. Would it be appropriate to deliver nutrition workshops and advise on sugar reduction in isolation? No. However, for campaigns to be effective they must be feasible, targeted, unequivocal and ultimately tactical – taking small steps and maintaining momentum.

Causes of obesity are indeed multifactorial. Food preferences are shaped by a combination of genetic predispositions and environmental factors. Whilst manufacturers of foods high in fat, salt and sugar argue that it’s up to individuals to choose what to eat, they simultaneously spend millions of pounds marketing their products to ensure their food IS what individuals ‘choose’ to eat. Despite this, we’re made to believe that weight gain is a simple and conscious decision. It is not. Action on Sugar’s aim is to work alongside health professionals, the government and the food industry to make healthier eating easier for everybody, regardless of their educational level or social status.

There are many reasons why Action on Sugar is not a lone voice in sugar reduction. The Scientific Advisory Committee on Nutrition (SACN), Public Health England (PHE), the Health Select Committee and over 40 members of the Obesity Health Alliance also agree, based on the best evidence available, that sugar intake should be reduced as it contains no nutritional value, yet causes tooth decay and is associated with an increased risk of weight gain and type 2 diabetes. Fat, which contains twice as many calories as sugar, must be reduced in order to tackle overall energy intake and therefore is also on the agenda, but the method is different; launching a high publicity campaign on fat, before SACN publish their evidence review, would be counterproductive and sabotaged by contention within the profession. Our campaigning pressured the government into publishing an obesity plan, which includes a national sugar reduction programme and a commitment to launch calorie (fat) and salt reduction programmes later this year.

Using the media to highlight the huge variations in the amount of sugars pressures companies into taking some responsibility for what they put in our food and drinks. Reformulation programmes – sugar, salt or fat – do not demonise foods, nor do they require behaviour change (you can still eat your favourite foods, at the same price). In foods, the 20% reduction in sugar required by 2020 can be made without increasing the overall calorie content of the product or affecting taste, by using non-nutritive sweeteners, complex carbohydrates including fibre (to an extent!), protein and by using new technologies – which are continuing to evolve. Sugar reduction (especially in the most sugary products) is possible, proven by the fact that the amount of sugar in like-for-like products varies by more than 20% across brands.

Sugar reformulation is easier in drinks as the weight of the sugar doesn’t need to be replaced. The Soft Drinks Industry Levy (SDIL) is effectively a regulated reformulation programme. Some of the biggest brands have already committed to significantly reduce the amount of sugar in their drinks. Whilst proving successful, the SDIL is just one approach out of many needed to prevent obesity.

The role of sugar reduction as part of the bigger picture must be understood. My predictions for 5-10 years’ time differ to Simon’s; I predict there will be progress in salt, sugar and calorie (fat) reduction and therefore the overall energy and nutrient value of foods at source. Sugar reduction is critical for public health in its own right, but also as the catalyst for wider obesity prevention strategies. Reducing a component of our diet that contributes to an increased risk of obesity, type 2 diabetes and tooth decay is not a ‘disservice’; it is essential. One thing is certain; ‘demonising’ Action on Sugar won’t benefit anyone.